Affiliation:
1. Department of Health Policy and Management, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
2. Division of Health Care Delivery Research Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic Rochester Minnesota USA
3. Division of Cardiology, UNC School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
4. Cecil G. Sheps Center for Health Services Research University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
5. Department of Family Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina USA
Abstract
AbstractRationaleExisting literature describing differences in survival following percutaneous coronary intervention (PCI) by patient sex, race‐ethnicity and the role of socioeconomic characteristics (SEC) is limited.Aims and ObjectivesEvaluate differences in 1‐year survival after PCI by sex and race‐ethnicity, and explore the contribution of SEC to observed differences.MethodsUsing a 20% sample of Medicare claims data for beneficiaries aged 65+, we identified fee‐for‐service patients who received PCI from 2007 to 2015. We performed logistic regression to assess how sex and race‐ethnicity relate to procedural indication, inpatient versus outpatient setting, and 1‐year mortality. We evaluated whether these relationships are moderated by sequentially controlling for factors including age, comorbidities, presence of acute myocardial infarction (AMI), county SEC, medical resource availability and inpatient versus outpatient procedural status.ResultsWe identified 300,491 PCI procedures, of which 94,863 (31.6%) were outpatient. There was a significant transition to outpatient PCI during the study period, especially for men compared with women and White patients compared with Black patients. Black patients were 3.50 percentage points (p < 0.001) and women were 3.41 percentage points (p < 0.001) more likely than White and male patients to undergo PCI at the time of AMI, which typically occurs in the inpatient setting. Controlling for age and calendar year, Black patients were 2.87 percentage points more likely than non‐Hispanic White patients to die within 1 year after PCI. After controlling for Black–White differences in comorbidities, the differences in 1‐year mortality decreased to 0.95 percentage points, which then became nonsignificant when further controlling for county resources and state of residence.ConclusionWomen were more likely to experience PCI in the setting of AMI and had less transition to outpatient care during the period. Black patients experienced higher 1‐year mortality following PCI, which is explained by differences in baseline comorbidities, county medical resources, and state of residence.
Funder
North Carolina Translational and Clinical Sciences Institute, University of North Carolina at Chapel Hill
Subject
Public Health, Environmental and Occupational Health,Health Policy